SEC FORM 3 SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
 
OMB APPROVAL
OMB Number: 3235-0104
Estimated average burden
hours per response: 0.5
1. Name and Address of Reporting Person*
HORNBECK TODD M

(Last) (First) (Middle)
103 NORTHPARK BOULEVARD
SUITE 300

(Street)
COVINGTON LA 70433

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
03/25/2004
3. Issuer Name and Ticker or Trading Symbol
HORNBECK OFFSHORE SERVICES INC /LA [ HOS ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
President, CEO, Secretary
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 523,094 D
Common Stock 200,000(1) I by family trust
Common Stock 477,160(2) I by power of attorney
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Options (right to buy) 02/25/1999(3) 02/25/2009 Common Stock 7,000 4.63 D
Stock Options (right to buy) 03/01/2000(4) 03/01/2010 Common Stock 10,000 5.1 D
Stock Options (right to buy) 03/09/2001(5) 03/09/2011 Common Stock 60,000 6.63 D
Stock Options (right to buy) 03/13/2004(6) 03/13/2013 Common Stock 25,500 11.2 D
Stock Options (right to buy) 02/17/2005(7) 02/17/2014 Common Stock 60,000 13.83 D
Explanation of Responses:
1. Represents shares held in trust for various members of Todd M. Hornbecks family over which Mr. Hornbeck holds voting power as trustee or by power of attorney. Mr. Hornbeck disclaims beneficial ownership of these securities, and this report shall not be deemed as an admission that Mr. Hornbeck is the beneficial owner of the securities for purposes of Section 16 or for any other purpose.
2. Represents shares owned by Troy Hornbeck over which Todd M. Hornbeck holds voting power pursuant to a power of attorney. Mr. Hornbeck disclaims beneficial ownership of these securities, and this report shall not be deemed as an admission that Mr. Hornbeck is the beneficial owner of the securities for purposes of Section 16 or for any other purpose.
3. The option provides for vesting in three equal annual installments commencing on 02/25/1999.
4. The option provides for vesting in three annual installments commencing on 03/01/2000.
5. The option provides for vesting in five equal annual installments commencing on 03/09/2001.
6. The option provides for vesting in three equal annual installments commencing on 03/13/2004.
7. The option provides for vesting in three equal annual installments commencing on 02/17/2005.
Remarks:
This form gives effect to a 1-to-2.5 reverse stock split effected March 5, 2004.
/s/ Todd M. Hornbeck 03/25/2004
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.